DOCSLIB.ORG

Goiter WHAT IS the THYROID GLAND? Hashimoto’S Thyroiditis Is a More Common Cause of Goiter Formation in the US

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

AMERICAN THYROID ASSOCIATION® www.thyroid.org Goiter WHAT IS THE THYROID GLAND? Hashimoto’s thyroiditis is a more common cause of goiter formation in the US. This is an autoimmune condition The thyroid gland is a butterfly-shaped endocrine gland in which there is destruction of the thyroid gland by that is normally located in the lower front of the neck. one’s own immune system. As the gland becomes more The thyroid’s job is to make thyroid hormones, which damaged, it is less able to make adequate supplies of are secreted into the blood and then carried to every thyroid hormone. The pitu itary gland senses a low thyroid tissue in the body. Thyroid hormones help the body use hormone level and secretes more TSH to stimulate the energy, stay warm and keep the brain, heart, muscles, thyroid. This stimulation causes the thyroid to grow, and other organs working as they should. which may produce a goiter. WHAT ARE THE SYMPTOMS OF A GOITER? Another common cause of goiter is Graves’ dis ease. The term “goiter” simply refers to the abnormal enlarge- In this case, one’s immune system produces a protein, ment of the thyroid gland. It is important to know that called thyroid stimulating immunoglobulin (TSI). As the presence of a goiter does not necessarily mean that with TSH, TSI stimulates the thyroid gland to enlarge the thyroid gland is malfunctioning. A goiter can occur producing a goiter. However, TSI also stimulates the in a gland that is producing too much hormone (hy- thyroid to make too much thyroid hor mone (causes perthyroidism), too little hormone (hypothyroidism), or hyperthyroidism). Since the pituitary senses too much the correct amount of hormone (euthyroidism). A goiter thyroid hormone, it stops secret ing TSH. In spite of this indicates there is a condition present which is causing the thyroid gland continues to grow and make thyroid the thyroid to grow abnormally. hormone. Therefore, Graves’ disease produces a goiter and hyperthy roidism. WHAT CAUSES A GOITER? Multinodular goiters are another common cause of One of the most common causes of goiter formation goiters. Individuals with this disorder have one or worldwide is iodine deficiency. While this was a very more nodules within the gland which cause thyroid frequent cause of goiter in the United States many enlargement. This is often detected as a nodu lar feeling years ago, it is no longer commonly observed. The gland on physical exam. Patients can present with a primary activity of the thyroid gland is to concentrate single large nodule or with multiple smaller nodules in the iodine from the blood to make thyroid hormone. The gland when first detected (see Thyroid Nodule brochure). gland cannot make enough thyroid hormone if it Thus, in early stages of a multinodular goiter with many does not have enough iodine. Therefore, with iodine small nodules, the overall size of the thyroid may not be deficiency the individual will become hypothyroid. enlarged yet. Unlike the other goiters discussed, the Consequently, the pituitary gland in the brain senses cause of this type of goiter is not well understood. the thyroid hormone level is too low and sends a sig nal In addition to the common causes of goiter, there are to the thyroid. This signal is called thyroid stimu lating many other less common causes. Some of these are hormone (TSH). As the name implies, this hormone due to genetic defects, others are related to injury or stimulates the thyroid to produce thyroid hormone and infections in the thyroid, and some are due to tumors to grow in size. This abnormal growth in size produces (both cancerous and benign tumors). what is termed a “goiter.” Thus, io dine deficiency is one cause of goiter development. Wherever iodine deficiency is common, goiter will be common. It remains a common cause of goiters in other parts of the world. This page and its contents are Copyright © 2019 1 the American Thyroid Association® AMERICAN THYROID ASSOCIATION® www.thyroid.org Goiter HOW DO YOU DIAGNOSE A GOITER? HOW IS A GOITER TREATED? As mentioned earlier, the diagnosis of a goiter is usually The treatment will depend upon the cause of the goiter. If made at the time of a physical examination when an the goiter was due to a deficiency of iodine in the diet (not enlargement of the thyroid is found. However, the common in the United States), you will be given iodine presence of a goiter indicates there is an abnormality of supplementation given in preparations to take by mouth. the thyroid gland. Therefore, it is important to determine This will lead to a reduction in the size of the goiter, but the cause of the goiter. As a first step, you will likely often the goiter will not completely resolve. have thyroid function tests to determine if your thyroid If the goiter is due to Hashimoto’s Thyroiditis, and you is underactive or overactive (see Thyroid Function Tests are hypothyroid, you will be given thyroid hormone brochure). Any subsequent tests performed will be supplement as a daily pill. This treatment will restore your dependent upon the results of the thyroid function tests. If thyroid hormone levels to normal, but does not usually the thyroid is diffusely enlarged and you are hyperthyroid, make the goiter go completely away. While the goiter may your doctor will likely proceed with tests to help diagnose get smaller, sometimes there is too much scar tissue in Graves’ Disease (see Graves’ Disease brochure). the gland to allow it to get much smaller. However, thyroid If you are hypothyroid, you may have Hashimoto’s hormone treatment will usually prevent it from getting any Thyroiditis (see Hypothyroidism brochure) and you may larger. Although appropriate in some individuals, surgery get additional blood tests to confirm this diagnosis. is usually not routine treatment of thyroiditis. Other tests used to help diagnose the cause of the If the goiter is due to hyperthyroidism, the treatment will goiter may include a radioactive iodine scan, thyroid depend upon the cause of the hyperthyroidism (see ultrasound, or a fine needle aspiration biopsy (see Hyperthyroidism and Graves’ disease brochures). For Thyroid Nodule brochure). some causes of hyperthyroidism, the treatment may lead to a disappearance of the goiter. For example, treatment of Graves’ disease with radioactive iodine usually leads to a decrease or disappearance of the goiter. Many goiters, such as the multinodular goiter, are associated with normal levels of thyroid hormone in the blood. These goiters usually do not require any specific treatment after the appropriate diagnosis is made. If no specific treatment is suggested, you may be warned that you are at risk for becoming hypothyroid or hyperthyroid in the future. However, if there are problems associated with the size of the thyroid per se, such as the goiter getting so large that it constricts the airway, your doctor may suggest that the goiter be treated by surgical removal. Whatever the cause, it is important to have regular (annual) monitoring when diagnosed with a goiter. FURTHER INFORMATION Further details on this and other thyroid-related topics are available in the patient thyroid ® This page and its contents information section on the American Thyroid Association website at www.thyroid.org. are Copyright © 2019 2 the American Thyroid Association® For information on thyroid patient support organizations, please visit the Patient Support Links section on the ATA website at www.thyroid.org.
Recommended publications
  • Hashimoto's Thyroiditis

    Hashimoto's Thyroiditis

    AMERICAN THYROID ASSOCIATION® www.thyroid.org Hashimoto’s Thyroiditis (Lymphocytic Thyroiditis) WHAT IS THE THYROID GLAND? HOW IS THE DIAGNOSIS OF HASHIMOTO’S The thyroid gland is a butterfly-shaped endocrine gland THYROIDITIS MADE? that is normally located in the lower front of the neck. The diagnosis of Hashimoto’s thyroiditis may be made The thyroid’s job is to make thyroid hormones, which are when patients present with symptoms of hypothyroidism, secreted into the blood and then carried to every tissue often accompanied by a goiter (an enlarged thyroid in the body. Thyroid hormones help the body use energy, gland) on physical examination, and laboratory testing of stay warm and keep the brain, heart, muscles, and other hypothyroidism, which is an elevated thyroid stimulating organs working as they should. hormone (TSH) with or without a low thyroid hormone (Free WHAT IS HASHIMOTO’S THYROIDITIS? thyroxine [Free T4]) levels. TPO antibody, when measured, is usually elevated. The term “Thyroiditis” refers to “inflammation of the thyroid gland”. There are many possible causes of thyroiditis (see Occasionally, the disease may be diagnosed early, Thyroiditis brochure). Hashimoto’s thyroiditis, also known especially in people with a strong family history of thyroid as chronic lymphocytic thyroiditis, is the most common disease. TPO antibody may be positive, but thyroid cause of hypothyroidism in the United States. It is an hormone levels may be normal or there may only be autoimmune disorder involving chronic inflammation of isolated mild elevation of serum TSH is seen. Symptoms of the thyroid. This condition tends to run in families. Over hypothyroidism may be absent.
  • Thyroid Nodules the American Thyroid Association®

    Thyroid Nodules the American Thyroid Association®

    ® This page and its contents are Copyright © 2018 Thyroid Nodules the American Thyroid Association® FAQPage 1 of 2 WHAT IS THE THYROID GLAND? The thyroid gland located in the neck produces thyroid hormones which help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally. 1 SYMPTOMS What are the symptoms of a thyroid nodule? The term thyroid nodule refers to any growth of thyroid cells that forms a lump within the thyroid. Most thyroid nodules do not cause any symptoms. Rarely, a nodule can cause pain, difficulty swallowing or breathing, hoarseness, or symptoms of hyperthyroidism. 2 CAUSES What causes a thyroid nodule? Fortunately, 9 out of 10 nodules are benign (noncancerous). These include colloid nodules, follicular neoplasms, and thyroid cysts. Autonomous nodules, which overproduce thyroid hormone, can occasionally lead to hyperthyroidism. We do not know what causes most noncancerous thyroid nodules to grow. Thyroid cancer is the most important cause of a thyroid nodule. Fortunately, cancer occurs in less than 10% of nodules (see Thyroid Cancer brochure). 3 DIAGNOSIS How is a thyroid nodule diagnosed? Most nodules are discovered during an examination of the neck for another reason. Blood tests of thyroid hormone (thyroxine, or T4) and thyroid-stimulating hormone (TSH) are usually normal. Specialized tests are necessary to determine whether a thyroid nodule is cancerous. You may be asked to undergo testing, such as a thyroid ultrasound, thyroid fine needle biopsy, or a thyroid scan. What is a Thyroid ultrasound? Thyroid ultrasound, which uses sound waves to obtain a picture of the thyroid should be used to evaluate thyroid nodules.
  • The Thyroid Nodule Clinic INSIDE THIS ISSUE the Challenge Most Thyroid Nodules—About 95%—Are Entirely Points to Remember Benign

    The Thyroid Nodule Clinic INSIDE THIS ISSUE the Challenge Most Thyroid Nodules—About 95%—Are Entirely Points to Remember Benign

    Current Trends in the Practice of Medicine Vol. 27, No. 1, 2011 The Thyroid Nodule Clinic INSIDE THIS ISSUE The Challenge Most thyroid nodules—about 95%—are entirely Points to Remember benign. However, identifying the occasional 2 Perspectives on thyroid cancer requires careful evaluation of every • Thyroid nodules are common, with the Continuing nodule found, using a combination of clinical palpable nodules found in 4% to 7% of Evolution of Therapy assessment, neck palpation, ultrasound imaging the adult US population and solitary or for Atrial Fibrillation (Figure 1), and, in many cases, analysis of a biopsy multiple nodules found at much higher specimen (Figure 2, see page 2). rates during ultrasonographic screening. Sometimes, thyroid nodules are noticed by 4 Advances in Seizure the patient or a family member or are discovered • Early diagnosis improves the likelihood Prevention and Prediction during a routine physical examination. They rarely that a cancer can be discovered while still cause symptoms, unless they are large enough contained within the thyroid gland and to interfere with swallowing. Thyroid cancer can amenable to surgery. 6 Childhood Fractures: invade and damage the recurrent laryngeal nerve, When to Worry causing hoarseness. Such invasion and damage are • Mayo Clinic endocrinologists opened the infrequent, however. Most nodules are incidental Thyroid Nodule Clinic in 2009, providing A discoveries, and now many more such nodules are coordinated care, a thorough assessment, discovered because of the increased use of imaging and a definitive diagnosis completed at a performed for other reasons, including carotid single visit. ultrasonography, neck or chest computed tomog- raphy, magnetic resonance imaging, and even positron emission tomography.
  • Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

    Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

    THYROID Volume 16, Number 2, 2006 © American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer The American Thyroid Association Guidelines Taskforce* Members: David S. Cooper,1 (Chair), Gerard M. Doherty,2 Bryan R. Haugen,3 Richard T. Kloos,4 Stephanie L. Lee,5 Susan J. Mandel,6 Ernest L. Mazzaferri,7 Bryan McIver,8 Steven I. Sherman,9 and R. Michael Tuttle10 Contents 1. Introduction . 4 2. Methods . 4 a. Literature search strategy b. Evaluation of the evidence 3. Thyroid Nodules . 5 a. Thyroid nodule evaluation iii. Laboratory studies iii. Fine needle aspiration biopsy iii. Multinodular goiter b. Thyroid nodule follow up and treatment ii. Long-term follow-up iii. Role of medical therapy iii. Thyroid nodules and pregnancy 4. Differentiated Thyroid Cancer . 8 a. Goals of therapy b. Role of preoperative staging with diagnostic testing c. Surgery for differentiated thyroid cancer iii. Extent of initial surgery iii. Completion thyroidectomy d. Pathological and clinical staging systems e. Postoperative radioiodine remnant ablation iii. Modes of thyroid hormone withdrawal iii. Role of diagnostic scanning before ablation iii. Radioiodine ablation dosage iv. Use of recombinant human thyrotropin for remnant ablation iv. Role of low iodine diets vi. Performance of post therapy scans f. Thyroxine suppression therapy g. Role of adjunctive external beam radiation or chemotherapy 5. Differentiated Thyroid Cancer: Long-Term Management . 13 a. Risk stratification for follow-up intensity b. Utility of serum thyroglobulin measurements c. Role of diagnostic radioiodine scans, ultrasound, and other imaging techniques d. Long-term thyroxine suppression therapy e. Management of patients with metastatic disease iii.
  • Thyroiditis: an Integrated Approach LORI B

    Thyroiditis: an Integrated Approach LORI B

    Thyroiditis: An Integrated Approach LORI B. SWEENEY, MD, Virginia Commonwealth University Health System, Richmond, Virginia CHRISTOPHER STEWART, MD, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana DAVID Y. GAITONDE, MD, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia Thyroiditis is a general term that encompasses several clinical disorders characterized by inflammation of the thyroid gland. The most common is Hashimoto thyroiditis; patients typically present with a nontender goiter, hypothyroid- ism, and an elevated thyroid peroxidase antibody level. Treatment with levothyroxine ameliorates the hypothyroid- ism and may reduce goiter size. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. Release of preformed thyroid hormone into the bloodstream may result in hyperthyroidism. This may be followed by transient or permanent hypothyroidism as a result of depletion of thyroid hormone stores and destruction of thyroid hormone–producing cells. Patients should be monitored for changes in thyroid function. Beta blockers can treat symptoms in the initial hyperthyroid phase; in the subsequent hypothyroid phase, levothyroxine should be considered in women with a serum thyroid-stimulating hormone level greater than 10 mIU per L, or in women with a thyroid-stimulating hormone level of 4 to 10 mIU per L who are symptomatic or desire fertility. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed thyroid-stimulating hormone, and low radioactive iodine uptake on thyroid scanning. Many cases of subacute thyroiditis follow an upper respiratory viral illness, which is thought to trigger an inflammatory destruction of thyroid follicles. In most cases, the thyroid gland spontaneously resumes normal thyroid hormone production after several months.
  • Management of Graves Disease:€€A Review

    Management of Graves Disease:€€A Review

    Clinical Review & Education Review Management of Graves Disease A Review Henry B. Burch, MD; David S. Cooper, MD Author Audio Interview at IMPORTANCE Graves disease is the most common cause of persistent hyperthyroidism in adults. jama.com Approximately 3% of women and 0.5% of men will develop Graves disease during their lifetime. Supplemental content at jama.com OBSERVATIONS We searched PubMed and the Cochrane database for English-language studies CME Quiz at published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 sys- jamanetworkcme.com and tematic reviews and meta-analyses, and 52 observational studies were included in this review. CME Questions page 2559 Patients with Graves disease may be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-total thyroidectomy). The optimal approach depends on patient preference, geog- raphy, and clinical factors. A 12- to 18-month course of antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reac- tions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of therapy. Treating Graves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement. Use of RAI has also been associ- ated with the development or worsening of thyroid eye disease in approximately 15% to 20% of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid Author Affiliations: Endocrinology eye disease who cannot be treated using antithyroid drugs.
  • Treating Thyroid Disease: a Natural Approach to Healing Hashimoto's

    Treating Thyroid Disease: a Natural Approach to Healing Hashimoto's

    Treating Thyroid Disease: A Natural Approach to Healing Hashimoto’s Melissa Lea-Foster Rietz, FNP-BC, BC-ADM, RYT-200 Presbyterian Medical Services Farmington, NM [email protected] Professional Disclosures I have no personal or professional affiliation with any of the resources listed in this presentation, and will receive no monetary gain or professional advancement from this lecture. Talk Objectives • Define hypothyroidism and Hashimoto’s. • Discuss various tests used to identify thyroid disease and when to treat based on patient symptoms • Discuss potential causes and identify environmental factors that contribute to disease • Describe how the gut (food sensitivities) and the adrenals (chronic stress) are connected to Hashimoto’s and how we as practitioners can work to educate patients on prevention before the need for treatment • How the use of adaptogens can enhance the treatment of Hashimoto’s and identify herbs that are showing promise in the research. • How to use food, exercise, and relaxation to improve patient outcomes. Named for Hakuro Hashimoto, a physician working in Europe in the early 1900’s. Hashimoto’s was the first autoimmune disease to be recognized in the scientific literature. It is estimated that one in five people suffer from an autoimmune disease and the numbers continue to rise. Women are more likely than men to develop an autoimmune disease, and it is believed that 75% of individuals with an autoimmune disease are female. Thyroid autoimmune disease is the most common form, and affects 7-8% of the population in the United States. Case Study Ms. R is a 30-year-old female, mother of three, who states that after the birth of her last child two years ago she has felt the following: • Loss of energy • Difficulty losing weight despite habitual eating pattern • Hair loss • Irregular menses • Joints that ache throughout the day • A general sense of sadness • Cold Intolerance • Joint and Muscle Pain • Constipation • Irregular menstruation • Slowed Heart Rate What tests would you run on Ms.
  • Hashimoto Thyroiditis

    Hashimoto Thyroiditis

    Hashimoto thyroiditis Description Hashimoto thyroiditis is a condition that affects the function of the thyroid, which is a butterfly-shaped gland in the lower neck. The thyroid makes hormones that help regulate a wide variety of critical body functions. For example, thyroid hormones influence growth and development, body temperature, heart rate, menstrual cycles, and weight. Hashimoto thyroiditis is a form of chronic inflammation that can damage the thyroid, reducing its ability to produce hormones. One of the first signs of Hashimoto thyroiditis is an enlargement of the thyroid called a goiter. Depending on its size, the enlarged thyroid can cause the neck to look swollen and may interfere with breathing and swallowing. As damage to the thyroid continues, the gland can shrink over a period of years and the goiter may eventually disappear. Other signs and symptoms resulting from an underactive thyroid can include excessive tiredness (fatigue), weight gain or difficulty losing weight, hair that is thin and dry, a slow heart rate, joint or muscle pain, and constipation. People with this condition may also have a pale, puffy face and feel cold even when others around them are warm. Affected women can have heavy or irregular menstrual periods and difficulty conceiving a child ( impaired fertility). Difficulty concentrating and depression can also be signs of a shortage of thyroid hormones. Hashimoto thyroiditis usually appears in mid-adulthood, although it can occur earlier or later in life. Its signs and symptoms tend to develop gradually over months or years. Frequency Hashimoto thyroiditis affects 1 to 2 percent of people in the United States.
  • Feline Hyperthyroidism

    Feline Hyperthyroidism

    Feline Hyperthyroidism Sponsored by Feline Hyperthyroidism Feline hyperthyroidism is the most common endocrine disorder in middle-aged to left) are advanced. Blood testing and older cats. It occurs in about 10 percent of feline patients over 10 years of age. can reveal elevation of thyroid Hyperthyroidism is a disease caused by an overactive thyroid gland that secretes hormones to establish a diagnosis excess thyroid hormone. Cats typically have two thyroid glands, one gland on of hyperthyroidism. Occasionally, each side of the neck. One or both glands may be affected. The excess thyroid additional diagnostics may be hormone causes an overactive metabolism that stresses the heart, digestive tract, required to confirm the diagnosis. and many other organ systems. Because hyperthyroidism can occur along with other medical conditions, If your veterinarian diagnoses your cat with hyperthyroidism, your cat should and it affects other organs, a receive some form of treatment to control the clinical signs. Many cats that are comprehensive screening of your diagnosed early can be treated successfully. When hyperthyroidism goes untreated, Cat years prior to developing the disease Same cat with hyperthyroidism cat’s heart, kidneys, and other clinical signs will progress leading to marked weight loss and serious complications organ systems is imperative. due to damage to the cat’s heart, kidneys, and other organ systems. MANAGEMENT AND TREATMENT OPTIONS CLINICAL SIGNS If your veterinarian diagnoses your cat with hyperthyroidism, he or she will discuss If you observe any of the following behaviors or problems in your cat, contact and recommend treatment options for your cat. Four common treatments for feline your veterinarian because the information may alert them to the possibility that hyperthyroidism are available and each has advantages and disadvantages.
  • Thyroid Nodules Update in Diagnosis and Management Shrikant Tamhane1* and Hossein Gharib2,3

    Thyroid Nodules Update in Diagnosis and Management Shrikant Tamhane1* and Hossein Gharib2,3

    Tamhane and Gharib Clinical Diabetes and Endocrinology (2015) 1:11 DOI 10.1186/s40842-015-0011-7 REVIEW ARTICLE Open Access Thyroid nodules update in diagnosis and management Shrikant Tamhane1* and Hossein Gharib2,3 Abstract Thyroid nodules are very common. With widespread use of sensitive imaging in clinical practice, incidental thyroid nodules are being discovered with increasing frequency. Their clinical importance is primarily related to the need to exclude malignancy (4.0 to 6.5 percent of all thyroid nodules), assess for their functional status and any pressure symptoms caused by them. New Molecular tests are marketed for the assessment of thyroid nodules for the presence of cancer. The high prevalence of thyroid nodules requires evidence-based rational strategies for their differential diagnosis, risk stratification, treatment, and follow-up. This review addresses advances and controversies in thyroid nodule evaluation, including the new molecular tests, and their management considering the current guidelines and supporting evidence. Keywords: Thyroid, Thyroid Nodules, Molecular markers, Benign, Malignant, FNA, Management, Ultrasonography Introduction disorders, benign and malignant can cause thyroid nod- Thyroid nodule is a discrete lesion within the thyroid ules (Table 1) [1, 5]. gland that is radiologically distinct from the surrounding Fine needle aspiration (FNA) biopsy is the most accur- thyroid parenchyma. Thyroid nodules are common. ate method for evaluating thyroid nodules and helps to They are discovered as an accidental finding by a pa- identify patients who require surgical resection [6]. If a tient, or as an incidental finding during a routine phys- serum TSH is normal or elevated, and the nodule meets ical examination in 3 to 7 % [1] or by a radiologic criteria for sampling, the next step in the evaluation of a procedure: 67 % with ultrasonography (US) imaging, thyroid nodule is a FNA biopsy.
  • Graves' Disease Following the Occurrence of Hypothyroidism

    Graves' Disease Following the Occurrence of Hypothyroidism

    Henry Ford Hospital Medical Journal Volume 28 Number 2 Richmond W. Smith Jr. Testimonial Article 14 Issue 6-1980 Graves' Disease Following the Occurrence of Hypothyroidism A. R. Guansing D. D. Klink N. Engbring Y. Leung J. Chakravarty See next page for additional authors Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Guansing, A. R.; Klink, D. D.; Engbring, N.; Leung, Y.; Chakravarty, J.; and Wilson, S. (1980) "Graves' Disease Following the Occurrence of Hypothyroidism," Henry Ford Hospital Medical Journal : Vol. 28 : No. 2 . Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol28/iss2/14 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Graves' Disease Following the Occurrence of Hypothyroidism Authors A. R. Guansing, D. D. Klink, N. Engbring, Y. Leung, J. Chakravarty, and S. Wilson This article is available in Henry Ford Hospital Medical Journal: https://scholarlycommons.henryford.com/ hfhmedjournal/vol28/iss2/14 Henry Ford Hosp Med j Vol 28, No 2 and 3, 1980 Graves' Disease Following the Occurrence of Hypothyroidism A. R. Guansing, MD,* D. D. Klink, MD,* N. Engbring, MD,** Y. Leung, MD,*** J. chakravarty, MD,*** and S. Wilson, MD** Three patients with hypothyroidism of 15-48 months' dura­ negative antithyroglobulin and antimicrosomal antibody tion developed Graves' disease while on thyroid hormone titers. Two had demonstrable long-acting thyroid stimulator replacement therapy.
  • Thyroid Nodules MARY JO WELKER, M.D., and DIANE ORLOV, M.S., C.N.P

    Thyroid Nodules MARY JO WELKER, M.D., and DIANE ORLOV, M.S., C.N.P

    PRACTICAL THERAPEUTICS Thyroid Nodules MARY JO WELKER, M.D., and DIANE ORLOV, M.S., C.N.P. Ohio State University College of Medicine and Public Health, Columbus, Ohio Palpable thyroid nodules occur in 4 to 7 percent of the population, but nodules found incidentally on ultrasonography suggest a prevalence of 19 to 67 percent. The major- O A patient informa- ity of thyroid nodules are asymptomatic. Because about 5 percent of all palpable nod- tion handout on thy- roid nodules, written ules are found to be malignant, the main objective of evaluating thyroid nodules is to by the authors of this exclude malignancy. Laboratory evaluation, including a thyroid-stimulating hormone article, is provided on test, can help differentiate a thyrotoxic nodule from an euthyroid nodule. In euthyroid page 573. patients with a nodule, fine-needle aspiration should be performed, and radionuclide scanning should be reserved for patients with indeterminate cytology or thyrotoxico- sis. Insufficient specimens from fine-needle aspiration decrease when ultrasound guidance is used. Surgery is the primary treatment for malignant lesions, and the extent of surgery depends on the extent and type of disease. Ablation by postopera- tive radioactive iodine is done for high-risk patients—identified as those with metasta- tic or residual disease. While suppressive therapy with thyroxine is frequently used postoperatively for malignant lesions, its use for management of benign solitary thy- roid nodules remains controversial. (Am Fam Physician 2003;67:559-66,573-4. Copy- right© 2003 American Academy of Family Physicians.) Members of various thyroid nodule is a palpable jects 19 to 50 years of age had an incidental family practice depart- swelling in a thyroid gland with nodule on ultrasonography.